Cholera Emergency Spreads in South Sudan’s Capital

Mothers and children like these, and indeed whole communities, are at risk. Photo: C. Duroseau

NEW YORK, May 22, 2014—After the South Sudan Ministry of Health declared a cholera outbreak in the capital city of Juba on May 9th, the number of cases grew rapidly. A total of 266 cases have been reported thus far, resulting in 13 deaths—six at health facilities, and seven among community members who had not yet accessed treatment.

“Knowing how cholera manifests and spreads, my colleagues in the field and I view the number of cases and the rate of the spreading in Juba to be highly alarming,” says Andrea Tamburini, Director of Operations for Action Against Hunger. “Extremely swift and strategic action is needed if we are to avoid a truly massive outbreak.”

Young men are proving particularly vulnerable in this emergency, with 117 cholera cases, 54% of the total, reported among 15-34 year old males. The main risk factors for cholera in Juba likely include drinking untreated river water supplied to Juba via water tankers, poor latrine use, eating foods sold roadside at makeshift markets, poor personal hygiene practices like hand-washing, open defecation, and even poor community handling of dead bodies awaiting burial.

Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. Symptoms typically include severe cases of diarrhea and vomiting, which can lead to dangerous and rapid dehydration and electrolyte imbalance. Without quick oral rehydration therapy, intravenous fluid provision, and/or antibiotic treatment, it can result in death. It is for these reasons that multiple cases in a community and any indication of geographic spread indicate an emergency outbreak.

With six new suspected cases being evaluated outside of Juba, the World Health Organization has been coordinating with the Ministry of Health and mobilizing partners including Action Against Hunger to scale up response and containment efforts. Initial steps being taken by the humanitarian community include streamlining staff supervision at the hospital, providing refresher training to staff on case management, and following up on suspected cases. Plans are shaping up to ship cholera response supplies to various locations, and to provide additional technical support and training to health workers.

Action Against Hunger launches response

In the midst of working in a challenging and volatile environment to thwart a complex national food emergency, Action Against Hunger is also expanding our programs in Juba to respond to the cholera outbreak. Our Cholera Response Team will work with other agencies in managing a specific geographic area within Juba, specifically managing all necessary water and sanitation activities needed to contain the spread of cholera and making referrals of suspected cases to health centers for treatment..

We have pre-positioned water treatment products and other cholera response products in neighboring Uganda, coordinating with our partners on the ground so we are ready to respond to the spread of the disease into Uganda’s refugee camps.

Action Against Hunger has a long expertise in water, sanitation, and hygiene (WaSH) response to cholera outbreaks and prevention, and has developed practical tools and operational positioning specific to this disease. We intervened in the latest major emergencies in Zimbabwe (2009-2012), in the Guinea Gulf region (2009- 2012), around the Lake Chad basin (2010-2011), and in D.R. Congo (2012-2014), among others. Complex urban emergencies involving cholera were addressed in Haiti’s capital Port-au-Prince following the earthquake (2010-2014), Abidjan in Cote d’Ivoire during the civil war (2010), and Conakry in Guinea (2011-2012).

Topic of focus at high-level donor meeting

Addressing the South Sudan Humanitarian Conference in Oslo, Norway Tuesday, United Nations Under-Secretary General for Humanitarian Affairs and Emergency Relief Coordinator Valerie Amos noted, “We need people to get access to health care. The Minister has already referred to the outbreak of cholera in Juba. We do not want to see a major health care crisis.”

Indeed cholera was a subject of discussion and concern in Oslo, where over 300 representatives from South Sudan, donor governments, regional organizations, international and national NGOs and UN agencies gathered at a high-level conference co-chaired by the Norwegian Ministry of Foreign Affairs and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Stakeholders met to take concrete steps to meet the urgent financial and operational needs of the humanitarian response to the South Sudan crisis.

Aid agencies sought a total of US$1.8 billion this year for South Sudan to save lives, prevent a famine and avert the loss of another generation of South Sudanese children. Unfortunately donor pledges fell far short, totaling $600 million in new funding for both South Sudan and the region. We at Action Against Hunger join our humanitarian colleague agencies in appealing to donor countries to do much more, and in calling on concerned individuals to show their support in the wake of this crisis.